# SELF MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SELF MEDICAL GROUP
- **Other names:** Internal Medicine of the Piedmont, A Division of Self Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588969448
- **Legal business name:** SELF MEDICAL GROUP
- **Authorized official:** DR. MATTHEW T LOGAN MD (PRESIDENT AND CHIEF EXECUTIVE OFFIC)
- **Authorized official phone:** (864) 725-4253

## Contact information

- **Practice address:** 104 LINER DRIVE, GREENWOOD, SC 29646
- **Practice address phone:** (864) 227-1115
- **Practice address fax:** (864) 227-2046
- **Mailing address:** 104 LINER DRIVE, GREENWOOD, SC 29646
- **Mailing address phone:** (864) 227-1115
- **Mailing address fax:** (864) 227-2046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/24/2011
- **Last updated:** 12/14/2021